Liver Health Maintenance Checklist
Use this checklist to assess your liver health habits and identify areas for improvement.
Full Name
*
First Name
Last Name
Email Address
example@example.com
Age
*
How often do you consume alcoholic beverages?
*
Never
Occasionally (less than once a week)
Weekly
Daily
Have you ever been diagnosed with hepatitis (A, B, or C)?
*
Yes
No
Not Sure
Do you regularly take any medications, including over-the-counter or herbal supplements?
*
Prescription medications
Over-the-counter medications
Herbal supplements
None
How would you describe your typical diet?
*
Balanced (fruits, vegetables, lean proteins, whole grains)
High in processed foods/fats
Vegetarian/Vegan
Other
How often do you engage in physical activity?
*
Daily
Several times a week
Rarely
Never
Have you experienced any of the following symptoms recently? (Select all that apply)
*
Fatigue
Yellowing of skin or eyes (jaundice)
Abdominal pain or swelling
Unexplained weight loss
None of the above
Have you ever had abnormal liver function tests?
*
Yes
No
Not Sure
Please rate your overall liver health maintenance practices.
*
1
2
3
4
5
Is there anything else you would like to share about your liver health or related concerns?
Submit Checklist
Should be Empty: